The clinical relevance of laboratory prognostic scores for patients with radiosurgically treated brain metastases of non-pulmonary primary tumor

Abstract Purpose To investigate the clinical value of the inflammation based prognostic scores for patients with radiosurgically treated brain metastases (BM) originating from non-pulmonary primary tumor (PT). Methods A retrospective analysis of 340 BM patients of different PT origin (melanoma, breast, gastrointestinal, or genitourinary cancer) was performed. Pre-radiosurgical laboratory prognostic scores, such as the Neutrophil-to-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and the modified Glasgow Prognostic Score (mGPS), were investigated within 14 days before the first Gamma Knife radiosurgical treatment (GKRS1). Results In our study cohort, the estimated survival was significantly longer in patients with NLR < 5 (p < 0.001), LMR > 4 (p = 0.001) and in patients with a mGPS score of 0 (p < 0.001). Furthermore, univariate and multivariate Cox regression models revealed NLR ≥ 5, LMR < 4 and mGPS score ≥ 1 as independent prognostic factors for an increased risk of death even after adjusting for age, sex, KPS, extracranial metastases status, presence of neurological symptoms and treatment with immunotherapy (IT) or targeted therapy (TT). Conclusions Summarizing previously published and present data, pre-radiosurgical mGPS and NLR groups seem to be the most effective and simple independent prognostic factors to predict clinical outcome in radiosurgically treated BM patients.

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Pre-radiosurgery leucocyte ratios and modified glasgow prognostic score predict survival in non-small cell lung cancer brain metastases patients

Journal of Neuro-Oncology ◽

10.1007/s11060-020-03660-z ◽

2020 ◽

Author(s):

Anna Cho ◽

Helena Untersteiner ◽

Dorian Hirschmann ◽

Fabian Fitschek ◽

Christian Dorfer ◽

...

Keyword(s):

Brain Metastases ◽

Cox Regression ◽

Prognostic Score ◽

Gamma Knife Radiosurgery ◽

Glasgow Prognostic Score ◽

Lymphocyte Ratio ◽

Risk Of Death ◽

Lymphocyte To Monocyte Ratio ◽

Modified Glasgow Prognostic Score ◽

Nsclc Patients

Abstract Introduction The predictive value of the pre-radiosurgery Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR) and the modified Glasgow Prognostic Score (mGPS) was assessed for the first time in a homogenous group of NSCLC brain metastaes (BM) patients. Methods We retrospectively evaluated 185 NSCLC-BM patients, who were treated with Gamma Knife Radiosurgery (GKRS). Patients with immunotherapy or targeted therapy were excluded. Routine laboratory parameters were reviewed within 14 days before GKRS1. Results Median survival after GKRS1 was significantly longer in patients with NLR < 5 (p < 0.001), PLR < 180 (p = 0.003) and LMR ≥ 4 (p = 0.023). The Cox regression model for the continuous metric values revealed that each increase in the NLR of 1 equaled an increase of 4.3% in risk of death (HR: 1.043; 95%CI = 1.020–1.067, p < 0.001); each increase in the PLR of 10 caused an increase of 1.3% in risk of death (HR: 1.013; 95%CI = 1.004–1.021; p = 0.003) and each increase in the LMR of 1 equaled a decrease of 20.5% in risk of death (HR: 0.795; 95%CI = 0.697–0.907; p = 0.001). Moreover, the mGPS group was a highly significant predictor for survival after GKRS1 (p < 0.001) with a HR of 2.501 (95%CI = 1.582–3.954; p < 0.001). NLR, PLR, LMR values and mGPS groups were validated as independent prognostic factors for risk of death after adjusting for sex, KPS, age and presence of extracranial metastases. Conclusion NLR, PLR, LMR and mGPS represent effective and simple tools to predict survival in NSCLC patients prior to radiosurgery for brain metastases.

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Glasgow Prognostic Score Is Superior to Other Inflammation-Based Scores in Predicting Survival of Diffuse Large B-Cell Lymphoma

Blood ◽

10.1182/blood.v126.23.1454.1454 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1454-1454

Author(s):

Xiaoxiao Hao ◽

Yongqiang Wei ◽

Fen Huang ◽

Xiaolei Wei ◽

Yuankun Zhang ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Prognostic Score ◽

Univariate Analysis ◽

Glasgow Prognostic Score ◽

B Cell Lymphoma ◽

Prognostic Scores ◽

Lymphocyte Ratio ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Inflammation-based prognostic scores, such as the glasgow prognostic score (GPS), prognostic index(PI), prognostic nutritional index(PNI), neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR) was related to survival in many solid tumors. Recent study showed that GPS can be used to predict outcome in diffuse large B-cell lymphoma(DLBCL). However other inflammation related scores had not been reported in DLBCL, and it also remained unknown which of them was more useful to evaluate the survival in DLBCL. In this retrospective study, a number of 252 newly diagnosed and histologically proven DLBCL patients from January 2003 to December 2014 were included. An elevated GPS, PI, NLR, PNI and PLR were all associated with decreased overall survival(p=0.000, p=0.000, p=0.006, p=0.001 and p=0.001, respectively) and event-free survival (p=0.000, p=0.000, p=0.011, p=0.001 and p=0.009, respectively) in univariate analysis. Multivariate analysis indicated that GPS(RR=1.768, 95%CI=1.043-3.000, p =0.034) remained an independent prognostic predictor in DLBCL. The area under the curve of GPS (0.735, 95%CI=0.645-0.824) was greater than that of PI(0.710, 95%CI=0.621-0.799), PNI(0.600, 95%CI=0.517-0.683), NLR(0.572, 95%CI=0.503-0.642), and PLR(0.599, 95%CI=0.510-0.689) by Harrell's C-statistics. Especially in the DLBCL patients treated with R-CHOP, GPS also remained the most powerful inflammation-based prognostic score when comparing with PI, NLR, PNI and PLR (p=0.004, p=0.000, respectively for OS and EFS). In conclusion, these results indicate that Inflammation-based prognostic scores such as GPS, PI, NLR, PNI and PLR can be used to evaluate the outcome in DLBCL patients. Among them, GPS is the most powerful tool in predicting survival in DLBCL patients, even in the rituximab era. Disclosures No relevant conflicts of interest to declare.

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Prognostic assessment in palliative cancer care: is there a difference between adult and older patients?

Geriatrics Gerontology and Aging ◽

10.53886/gga.e0210044 ◽

2021 ◽

Vol 15 ◽

Author(s):

Simone Garruth dos Santos Machado Sampaio ◽

Livia Costa Oliveira ◽

Karla Santos da Costa Rosa

Keyword(s):

Risk Factors ◽

Older People ◽

Older Patients ◽

Protective Factor ◽

Prognostic Score ◽

Glasgow Prognostic Score ◽

Nutritional Risk ◽

Factors Associated ◽

Risk Of Death ◽

Increased Risk

OBJECTIVE: To compare factors associated with death in adults and older people with advanced cancer who were hospitalized in a palliative care unit (PCU). METHODS: Case-control study with patients (adults vs older people) admitted to a PCU of National Cancer Institute José Alencar Gomes da Silva (INCA), in Rio de Janeiro, Brazil. Logistic regressions (odds ratio [OR] and 95% confidence interval [95%CI]) were used to identify factors associated with death. RESULTS: The study included 205 patients, most of which were aged over 60 years old (60.5%). Among the adult patients, a Karnofsky Performance Status ≤ 40% (OR 2.54 [95%CI 1.11–3.45]) and neutrophil-to-lymphocyte ratio (NLR) (OR 1.09 [95%CI 1.02–1.24]) were risk factors for death, while albumin (OR 0.30 [95%CI 0.12–0.78]) was a protective factor. Among older patients, NLR (OR: 1.13 [95%CI 1.02–1.24]), C-reactive protein (CRP) (OR 1.09 [95%CI 1.02–1.17]), modified Glasgow Prognostic Score (mGPS) 1 and 2 (OR 4.66 [95%CI 1.35–16.06]), CRP-to-albumin ratio (CAR) (OR 1.27 [95%CI 1.03–1.58]), and nutritional risk (OR 1.11 [95%CI 1.03–1.19]) were risk factors, whereas albumin (OR 0.23 [95%CI 0.09–0.57]) was a protective factor against death. CONCLUSIONS: Prognostic factors differed between groups. The NLR was a risk factor, and albumin was a protective factor regarding death in both groups. Additionally, CRP, mGPS, CAR, and nutritional risk were associated with an increased risk of death only among older people.

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Impacts of Inflammation-Based Prognostic Scores on Survival in Patients With Hypopharyngeal Squamous Cell Carcinoma

OTO Open ◽

10.1177/2473974x20978137 ◽

2020 ◽

Vol 4 (4) ◽

pp. 2473974X2097813

Author(s):

Hiroyuki Iuchi ◽

Takayuki Kyutoku ◽

Kotoko Ito ◽

Hayato Matsumoto ◽

Junichiro Ohori ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Prognostic Score ◽

Survival Rates ◽

Glasgow Prognostic Score ◽

University Hospital ◽

Prognostic Scores ◽

Hypopharyngeal Squamous Cell Carcinoma ◽

Lymphocyte Ratio

Objective To investigate the predictive accuracies of the modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) as prognostic factors for patients with hypopharyngeal squamous cell carcinoma (HSCC). Study Design Retrospective study. Setting University hospital. Methods The records of 106 patients who were histologically diagnosed with HSCC between January 2007 and December 2017 were reviewed. mGPS, NLR, and PLR were analyzed; univariate and multivariate analyses were performed to evaluate the prognosis of overall survival (OS). Results The overall 5-year survival rates of patients with mGPS0, mGPS1, and mGPS2 were 82.0%, 41.9%, and 13.5%, respectively. The overall 5-year survival rates of patients with low and high NLRs and with low and high PLRs were 83.8%, 46.2%, 57.0%, and 59.1%, respectively. mGPS ( P < .001) and NLR ( P < .05) were independently associated with OS, whereas PLR was not. For stage IV HSCC, only mGPS was independently associated with OS ( P = .004). Conclusion mGPS is an excellent prognostic factor for patients with HSCC.

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Usefulness of Inflammation-Based Prognostic Scores in Patients with Surgically Treated Pancreatic Ductal Adenocarcinoma

Journal of Clinical Medicine ◽

10.3390/jcm10245784 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5784

Author(s):

Sarang Hong ◽

Dae Wook Hwang ◽

Jae Hoon Lee ◽

Ki Byung Song ◽

Woohyung Lee ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Prognostic Score ◽

Pancreatic Head ◽

Glasgow Prognostic Score ◽

Tnm Stage ◽

Stage I ◽

Prognostic Scores ◽

Ductal Adenocarcinoma ◽

Significant Prognostic Factor ◽

Lymphocyte Ratio

In this study, we evaluated the prognostic value of inflammation-based prognostic scores in patients undergoing curative surgery for pancreatic ductal adenocarcinoma (PDAC). A retrospective analysis was conducted for 914 patients undergoing curative surgical resection for PDAC between January 2011 and April 2016. Inflammation-based scores of modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were assessed. mGPS was classified as high (1 or 2) or low (0). Median age was 63 (range, 33–88) years; 538 patients (58.9%) were male. A high mGPS was independently associated with poor overall survival (OS) and disease-free survival (DFS) (median OS: 25.4 months vs. 20.4 months, p = 0.001; median DFS: 11.6 months vs. 9.3 months, p = 0.002), poor OS in patients with TNM stage I PDAC (44 months vs. 24.8 months, p = 0.001), and poor OS and DFS in patients with tumors located at the pancreatic head or uncinate process (OS: 25.4 months vs. 20.4 months; p = 0.007, DFS: 11.4 months vs. 8.87 months; p = 0.005). Preoperative mGPS was a significant prognostic factor for PDAC after curative resection; thus, mGPS can be a useful prognostic predictive factor in patients with TNM stage I PDAC, especially for tumors located at the head and uncinate.

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Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia

Cancers ◽

10.3390/cancers13164232 ◽

2021 ◽

Vol 13 (16) ◽

pp. 4232

Author(s):

Rebecca Abdelmalak ◽

Mark P. Lythgoe ◽

Joanne Evans ◽

Michael Flynn ◽

Justin Waters ◽

...

Keyword(s):

Risk Stratification ◽

Prognostic Markers ◽

Prognostic Score ◽

Multivariable Analysis ◽

Glasgow Prognostic Score ◽

Prognostic Scores ◽

High Grade ◽

Ki 67 ◽

Lymphocyte Ratio ◽

Grade 3

Background: High-grade neuroendocrine tumours and carcinomas (NET/NECs) behave aggressively, typically presenting at an advanced stage. Prognosis is poor, with median survival between 5 and 34 months. The mainstay of treatment is palliative systemic therapy. However, therapy carries a risk of toxicity, which can reduce quality of life. Therefore, accurate prognostic scores for risk stratification of patients with high-grade NET/NECs are needed to help guide patient management to decide whether active treatment is likely to improve overall survival (OS). We aimed to compare the prognostic ability of published prognostic scores to predict OS in a cohort of patients with high-grade NET/NECs of any primary site. Methods: Treatment, biochemical and clinicopathological data were collected retrospectively from 77 patients with high-grade NET/NECs across three hospitals between 2016 and 2020. Variables including performance status (PS), Ki-67, age at diagnosis, previous treatment and presence of liver metastases were recorded. Pre-treatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, modified Glasgow prognostic score (mGPS), and gastrointestinal neuroendocrine carcinoma (GI-NEC) score were derived. Univariable and multivariable survival analyses were used to assess prognostic ability. Results: The median age of the cohort was 63 years (range: 31–85); 53% of subjects were female. Grade 3 NETs (G3-NETs) were identified in 32 patients and NECs in 45 patients. The median OS was 13.45 months (range: 0.87–65.37) with no difference observed between G3-NETs and NECs. Univariable analysis revealed that NLR (n = 72, p = 0.049), mGPS (n = 56, p = 0.003), GI-NEC score (n = 27, p = 0.0007) and Ki-67 (n = 66, p = 0.007) were significantly associated with OS. Multivariable analysis confirmed that elevated mGPS (p = 0.046), GI-NEC score (p = 0.036), and Ki-67 (p = 0.02) were independently prognostic for reduced OS across the entire cohort. mGPS was identified as an independent prognostic factor in G3-NETs. Independent predictors of OS in NECs were PS and Ki-67. Conclusions: mGPS, PS and Ki-67 are independent prognostic markers in high-grade NET/NEC patients. Our study supports the use of these prognostic scores for risk stratification of patients with high grade cancers and as useful tools to guide treatment decisions.

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Role of Inflammatory and Immune-Nutritional Prognostic Markers in Patients Undergoing Surgical Resection for Biliary Tract Cancers

Cancers ◽

10.3390/cancers13143594 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3594

Author(s):

Simone Conci ◽

Tommaso Campagnaro ◽

Elisa Danese ◽

Ezio Lombardo ◽

Giulia Isa ◽

...

Keyword(s):

Biliary Tract ◽

Cox Regression ◽

Prognostic Score ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Postoperative Mortality ◽

Prognostic Nutritional Index ◽

Term Survival ◽

Lymphocyte Ratio

The relationship between immune-nutritional status and tumor growth; biological aggressiveness and survival, is still debated. Therefore, this study aimed to evaluate the prognostic performance of different inflammatory and immune-nutritional markers in patients who underwent surgery for biliary tract cancer (BTC). The prognostic role of the following inflammatory and immune-nutritional markers were investigated: Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), Prognostic Nutritional Index (PNI). A total of 282 patients undergoing surgery for BTC were included. According to Cox regression and ROC curves analysis for survival, LMR had the best prognostic performances, with hazard ratio (HR) of 1.656 (p = 0.005) and AUC of 0.652. Multivariable survival analysis identified the following independent prognostic factors: type of BTC (p = 0.002), T stage (p = 0.014), N stage (p < 0.001), histological grading (p = 0.045), and LMR (p = 0.025). Conversely, PNI was related to higher risk of severe morbidity (p < 0.001) and postoperative mortality (p = 0.005). In conclusion, LMR appears an independent prognostic factor of long-term survival, whilst PNI seems associated with worse short-term outcomes.

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Surgery for primary tumor benefits survival for breast cancer patients with bone metastases: a large cohort retrospective study

BMC Cancer ◽

10.1186/s12885-021-07964-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhangheng Huang ◽

Xin Zhou ◽

Yuexin Tong ◽

Lujian Zhu ◽

Ruhan Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Bone Metastases ◽

Cancer Patients ◽

Primary Tumor ◽

Predictive Accuracy ◽

Rank Test ◽

Breast Cancer Patients ◽

Risk Of Death ◽

The Impact

Abstract Background The role of surgery for the primary tumor in breast cancer patients with bone metastases (BM) remains unclear. The purpose of this study was to determine the impact of surgery for the primary tumor in breast cancer patients with BM and to develop prognostic nomograms to predict the overall survival (OS) of breast cancer patients with BM. Methods A total of 3956 breast cancer patients with BM from the Surveillance, Epidemiology, and End Results database between 2010 and 2016 were included. Propensity score matching (PSM) was used to eliminate the bias between the surgery and non-surgery groups. The Kaplan-Meier analysis and the log-rank test were performed to compare the OS between two groups. Cox proportional risk regression models were used to identify independent prognostic factors. Two nomograms were constructed for predicting the OS of patients in the surgery and non-surgery groups, respectively. In addition, calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the performance of nomograms. Result The survival analysis showed that the surgery of the primary tumor significantly improved the OS for breast cancer patients with BM. Based on independent prognostic factors, separate nomograms were constructed for the surgery and non-surgery groups. The calibration and ROC curves of these nomograms indicated that both two models have high predictive accuracy, with the area under the curve values ≥0.700 on both the training and validation cohorts. Moreover, DCA showed that nomograms have strong clinical utility. Based on the results of the X-tile analysis, all patients were classified in the low-risk-of-death subgroup had a better prognosis. Conclusion The surgery of the primary tumor may provide survival benefits for breast cancer patients with BM. Furthermore, these prognostic nomograms we constructed may be used as a tool to accurately assess the long-term prognosis of patients and help clinicians to develop individualized treatment strategies.

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Hemogram as marker of in-hospital mortality in COVID-19

Journal of Investigative Medicine ◽

10.1136/jim-2021-001810 ◽

2021 ◽

pp. jim-2021-001810

Author(s):

Alejandro López-Escobar ◽

Rodrigo Madurga ◽

José María Castellano ◽

Santiago Ruiz de Aguiar ◽

Sara Velázquez ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admission ◽

White Blood Cells ◽

Rate Of Change ◽

Hospital Death ◽

Direct Role ◽

Lymphocyte Ratio ◽

Risk Of Death ◽

Rate Of Increase ◽

Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

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Prognostic Value of C-Reactive Protein, Glasgow Prognostic Score, and C-Reactive Protein-to-Albumin Ratio in Colorectal Cancer

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.637650 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jiahui Zhou ◽

Wene Wei ◽

Hu Hou ◽

Shufang Ning ◽

Jilin Li ◽

...

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Roc Curve ◽

Prognostic Score ◽

Glasgow Prognostic Score ◽

Stage I ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

Background: Emerging evidence suggests that inflammatory response biomarkers are predictive factors that can improve the accuracy of colorectal cancer (CRC) prognoses. We aimed to evaluate the prognostic significance of C-reactive protein (CRP), the Glasgow Prognostic Score (GPS), and the CRP-to-albumin ratio (CAR) in CRC.Methods: Overall, 307 stage I–III CRC patients and 72 colorectal liver metastases (CRLM) patients were enrolled between October 2013 and September 2019. We investigated the correlation between the pretreatment CRP, GPS, and CAR and the clinicopathological characteristics. The Cox proportional hazards model was used for univariate or multivariate analysis to assess potential prognostic factors. A receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value of each prognostic score. We established CRC survival nomograms based on the prognostic scores of inflammation.Results: The optimal cutoff levels for the CAR for overall survival (OS) in all CRC patients, stage I–III CRC patients, and CRLM patients were 0.16, 0.14, and 0.25, respectively. Kaplan–Meier analysis and log-rank tests demonstrated that patients with high CRP, CAR, and GPS had poorer OS in CRC, both in the cohorts of stage I–III patients and CRLM patients. In the different cohorts of CRC patients, the area under the ROC curve (AUC) of these three markers were all high. Multivariate analysis indicated that the location of the primary tumor, pathological differentiation, and pretreatment carcinoembryonic antigen (CEA), CRP, GPS, and CAR were independent prognostic factors for OS in stage I–III patients and that CRP, GPS, and CAR were independent prognostic factors for OS in CRLM patients. The predictors in the prediction nomograms included the pretreatment CRP, GPS, and CAR.Conclusions: CRP, GPS, and CAR have independent prognostic values in patients with CRC. Furthermore, the survival nomograms based on CRP, GPS, and CAR can provide more valuable clinical significance.

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